Effekt og sikkerhet av angiotensin reseptorblokkere med og uten diuretika hos pasienter med hypertensjon, hjertesvikt eller diabetisk nefropati

1-PAGE KEY MESSAGES Background Hypertension increases the risk of developing cardiovascular dis-eases, in particular myocardial infarction and stroke. Several types of drugs lower blood pressure and angiotensin receptor blockers (ARB) constitute one drug class. These drugs are also found in combination with thiazide diuretics. This report aimed to compare the different drugs within the ARB class with regard to efficacy and safety in patients with hypertension, heart failure and diabetic nephropathy. Method The report is an overview of systematic reviews. We have examined the effect of ARB on clinical endpoints like death, cardiovascular events (myocardial in-farct, stoke) and end stage renal disease. We performed systematic searches in Cochrane Library, Centre for Reviews and Dissemination databases, Medline (Ovid) and Embase (Ovid). Results We did not identify systematic reviews where drugs within the ARB class were directly compared. Neither did we find systematic reviews in which the combi-nation drugs were compared. This applied to all clinical endpoints and all patient populations examined in this report. Studies that compared the different ARBs with other active drug treatments or with placebo, with use of hard endpoints (death, cardiovascular events, end stage renal failure), are present but few. For most compari-sons with other active treatments significant differences with regard to efficacy have not been reported. Thus these studies could not be used as a basis for trying to undertake an indirect comparison between the different drugs within the ARB class. ARBs appeared to be well tolerated. The adverse events related to the ARBs varied between studies, and there were not sufficient data to determine whether differences existed between the different ARBs concerning specific adverse drug reactions. Conclusion It has not been documented that one or several drugs within the class of ARB are more efficacious or safer than the others in patients with hypertension, heart failure or diabetic nephropathy.